In ophthalmology, there are numerous organic and functional diseases that can be treated well with eye surgery as part of surgical ophthalmology or eye surgery (also known as ophthalmic surgery ). This article informs you about common eye diseases that usually require eye surgery for treatment.
In ophthalmology, there are numerous organic and functional diseases that can be treated well by means of eye surgery as part of surgical ophthalmology or eye surgery (ophthalmic surgery). Some eye diseases require eye surgery to be cured (e.g. cataracts), while others, such as defective vision, can be treated both conservatively (glasses) and with surgical ophthalmology (refractive surgery).
The main areas of surgical ophthalmology are
Most eye operations in surgical ophthalmology are now performed so frequently that they have become routine procedures that can safely and successfully treat the underlying disease.
Like everything else in our body, the lens of the eye is subject to the natural ageing process: it becomes cloudy over the course of a lifetime. This process varies from person to person. While some people notice clouding quite early on, for others it occurs very late.
However, certain medications as well as smoking or eye injuries can contribute to the lens becoming cloudy more quickly. Only in rare cases are cataracts congenital.
Symptoms of cataracts
The clouding of the lens develops slowly so that it is not always noticed immediately. Indications may be that the world suddenly appears blurred or a little dull, as if you were looking through a pane of frosted glass. Colors fade and those affected are sensitive to light, especially if they are dazzled.
As cataracts can also change the refractive power of the lens, some sufferers also notice that their vision changes.
The diagnosis of cataracts
At an advanced stage, cataracts can also be recognized by outsiders: the affected person's lens then appears cloudy and whitish.
If the cataract is not yet so advanced, a surgical ophthalmologist can diagnose it using a slit lamp examination. This involves looking at the eye through a slit lamp, which acts like a microscope. The surgical ophthalmologist may first "dilate" the eye with medication. Afterwards, patients should not drive for several hours.
Once the decision has been made in favor of a surgical ophthalmology operation, a series of preliminary examinations are carried out in which the entire eye is examined. Using ultrasound measurements, the doctor can precisely determine the artificial lens to be implanted.
A cataract can only be successfully cured by means of surgical ophthalmology. During cataract surgery, the cloudy lens is removed from the eye and replaced with a clear artificial lens.
Surgical ophthalmology is now so advanced that cataract surgery is one of the safest operations.
The timing of the operation depends primarily on the extent to which the cataract affects the patient's daily life. In most cases, cataract surgery can be performed on an outpatient basis and patients can usually return home just a few hours after the procedure.
Cataract surgery procedure
In cataract surgery in modern surgical ophthalmology, the entire lens, including the retaining apparatus, is generally no longer removed, but - if possible - the lateral and posterior lens capsule is left in the eye.
In the most common operation in surgical ophthalmology today (known as phacoemulsification), the lens capsule is opened in the anterior region with a tiny incision. The harder lens nucleus is liquefied with the help of ultrasound and - together with the softer lens cortex - suctioned out.
A folded soft artificial lens is usually inserted through the incision. If a harder lens is to be inserted, the doctor can also enlarge the incision. The lens is then centered and placed in the capsular bag with small clips.
The video shows the incision for lens fragmentation during cataract surgery:
Follow-up treatment after eye surgery
The operated eye is covered with an ointment dressing. It usually takes a few days for full visual acuity to return.
It is important not to rub or apply pressure to the operated eye under any circumstances. During the first few days after the operation, the eye should also not be overloaded by reading or watching television too much.
Physical exertion and visits to the sauna should also be avoided in the initial period after the operation in surgical ophthalmology.
In glaucoma, the fibers of the optic nerve gradually die off.
The causes of this death have not yet been conclusively researched in surgical ophthalmology. However, increased intraocular pressure, which damages the optic nerve, is an important risk factor. Increased blood pressure and restricted blood flow to the optic nerve (e.g. in diabetes) can also have an influence on the course of the disease.
Recent research in ophthalmology suggests that the cerebrospinal fluid surrounding the optic nerve may also be involved in the disease process, and disorders of the immune system are also being discussed.
Forms of glaucoma
There are various forms of glaucoma. The most common is open-angle glaucoma. In recent years, ophthalmologists have also focused on so-called normal-angle glaucoma. Angle-closure glaucoma, in which the intraocular pressure rises massively, is less common.
Symptoms of glaucoma
Unfortunately, those affected often only notice glaucoma when part of the optic nerve has already been irreversibly (irretrievably) damaged.
Indications of the disease can be blind spots at the edge of the visual field, which gradually become larger. These are often only noticed very late, as the second eye and the brain initially compensate for the loss.
The disease is also often noticed too late because it is usually painless. Only in the rare form of angle-closure glaucoma do severe pain in the eye, headaches and reddening of the eye suggest that something is wrong with the eye and that an ophthalmologist should be consulted.
If glaucoma remains untreated, it can lead to blindness
The diagnosis of glaucoma
The ophthalmologist first measures the intraocular pressure, as this is the decisive risk factor. He also assesses the macula, the part of the retina where the optic nerve leaves the eye, so that the ophthalmologist can see whether the optic nerve is damaged.
If only the intraocular pressure is measured, many glaucomas are overlooked. As additional examination methods in surgical ophthalmology, the doctor uses
are added. Retinatomography and optical coherence tomography are also important for follow-up.
For the treatment of most forms of glaucoma, eye drops with various active ingredients are available to reduce intraocular pressure. If the medication alone does not sufficiently reduce the intraocular pressure, surgical ophthalmology is used.
Surgical procedures for glaucoma
If the intraocular pressure cannot be lowered sufficiently with medication, an operation on the iris is performed to equalize the pressure between the posterior and anterior chamber of the eye.
In addition, a renewed blockage of the aqueous humor outflow is prevented by creating an artificial outflow for the aqueous humor so that the intraocular pressure does not rise again after the operation.
This glaucoma surgery is also usually performed under local anesthesia and can be performed on an outpatient basis.
In surgical ophthalmology, special laser surgery treatments can also help to reduce intraocular pressure. However, they usually only reduce intraocular pressure slightly and not permanently.
Acute glaucoma is an emergency and always requires immediate surgery.
Follow-up treatment after eye surgery for glaucoma
As with cataract aftercare, you should not rub or apply pressure to the eye after the operation. The eye should also be protected for the first few days after the operation. You should also avoid physical exertion and going to the sauna in the initial period after the eye operation.
The causes of age-related macular degeneration (AMD) have not yet been researched in detail. However, it is known that in AMD, metabolic products are deposited in the retina, particularly in the area of sharpest vision (the macula), and that these deposits lead to the death of retinal cells.
In some people affected, new but damaged blood vessels form. Known risk factors for AMD are age and smoking.
Forms of age-related macular degeneration
If only metabolic products are deposited and retinal cells die, this is referred to as dry AMD. If new, damaged blood vessels also form, this is known as wet AMD.
Symptoms of age-related macular degeneration
AMD does not cause any pain. Possible signs of the disease are a blind or grey spot in the middle of the visual field, a fading of colors and the fact that straight lines appear distorted.
Diagnosis of age-related macular degeneration
With a simple self-test, looking at tiles in the bathroom or kitchen, those affected can check for themselves whether straight lines appear distorted. The ophthalmologist can use the so-called Amsler grid for this test.
The doctor also examines the back of the eye with a special microscope. Further examination methods in surgical ophthalmology are
For certain stages of dry AMD, the surgical ophthalmologist will recommend a special combination of supplements.
The more aggressive wet form of AMD can now be successfully treated with medication. To do this, the surgical ophthalmologist injects a drug into the eyeball under sterile operating conditions to stop the progression of the vascular changes.
Age-related macular degeneration: surgical procedures
Surgical procedures for the treatment of AMD are still being tested and can therefore not yet be used routinely.
However, surgical intervention should be considered as soon as possible in the event of sudden, extensive bleeding under the retina or in the vitreous.
A high concentration of sugar in the blood of people with diabetes leads to medium-term damage to the fine blood vessels in the eye. This leads to vascular occlusion, as a result of which the visual cells are no longer adequately supplied. In addition, fluid leaks from the damaged vessels, which also damages the retina.
In severe cases, damaged blood vessels proliferate inside the eye and lead to bleeding into the eyeball. The final stage of the disease is retinal detachment and blindness.
Symptoms of diabetic retinopathy
For a long time, those affected do not notice any deterioration in vision, even if the ophthalmologist notices changes to the retina. At a later stage, blurred or distorted images or deterioration of vision or even blindness may occur.
Diagnosis of diabetic retinopathy
The doctor in surgical ophthalmology dilates the pupil with eye drops so that the peripheral areas of the retina can also be viewed with a microscope.
If the area of sharpest vision is affected by the diabetic retinopathy, optical coherence tomography can provide additional information, particularly as part of the follow-up.
To prevent diabetes from causing damage to the eye, it is important to keep blood sugar and blood pressure well controlled. Regular examinations by a surgical ophthalmologist (once a year) show whether further treatment of the eye is necessary.
In certain stages of diabetic retinopathy, the progression of the disease can be halted with laser therapy. This involves using a laser to destroy cells in the peripheral parts of the retina. This results in a better ratio between oxygen supply and oxygen demand. The areas of the retina not treated with the laser can now be better supplied with oxygen.
Eye surgery for diabetic retinopathy
In the case of advanced retinopathy, for example bleeding into the vitreous body or detachment of the retina, surgery can at least partially save sight in many cases. The vitreous body is removed(vitrectomy) and replaced with gas or silicone oil to reattach the retina.
Due to a hereditary predisposition, the photoreceptors gradually die off in people suffering from retinopathy pigmentosa. Initially, the rods responsible for seeing in twilight are affected, later the cones necessary for color vision.
The process usually takes decades and the disease progresses slowly or in relapses.
Symptoms of retinopathy pigmentosa
Initially, twilight and color vision decrease; the field of vision narrows more and more until so-called tunnel vision occurs. The final result is blindness.
Diagnosis of retinopathy pigmentosa
On examination of the retina, so-called bony structures are usually found. The optic nerve appears pale. The diagnosis can be confirmed using special methods such as electroretinography (ERG).
Surgical treatment of retinopathia pigmentosa
There are currently no proven treatment methods. However, retinal implants are already being developed at several centers in Germany to restore some vision to those affected.
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